Laserfiche WebLink
Wisconsin Department of Industry, WISCONSIN ADMINISTRATIVE Safety and Buildings Division <br /> Labor and Human Relations <br /> BUILDING PERMIT APPLICATION <br /> • (Wis.Stats. 101.63(7)& 101.65(3)) <br /> Submit to non-enforcing municipalities for new I-and 2-family dwellings. <br /> SEEINSTRUCTIONS ON BACK OF YELLOW COPY. <br /> The information you provide maybe used by other government agency programs[Privacy Law,s 1504(1)(m)]. <br /> PEKIMI F APPLICANT <br /> (CA .1 <br /> .. ..... wwwX ............. <br /> Last Name First Name Middle Initial <br /> Fri e, � CQ -S 0 6 <br /> Street Address <br /> City State Zip Code Telephone No.(include area code) <br /> sf � <br /> 7 ?, / <br /> Z../-Z/ <br /> ... xb: <br /> ]:xx� .. .... <br /> .................. <br /> ... .......... <br /> Building Address Subdivision Name M V, )5 Lot# Block # <br /> i7w4f, ?)0-q0 9 <br /> Legal Description L. Lt7r 3 Parcel No. <br /> 1/4, 1/4 ection T 4`6WN, R_/46 E oq!V <br /> �:��:��:�:.:����P!WJF..CT::HVAC,EQUIPMENT. xx <br /> 0 Ea TYPE <br /> I Family N Forced Air Furnace LJ Radiant Baseboard or Panel (Elec.) E] Heat Pump <br /> El 2 Family 0 Boiler E] Central AC 0 Other: <br /> ENERGY SOURCE Nat.Gas L.P. Oil Elect. Solid Solar <br /> Space Heating Llkll�_ El 11 <br /> El El <br /> Water Heating 0 1] El <br /> 4. ......... ... <br /> . ........... ... <br /> ................I..... <br /> PROJECT:: NSTRUCTION 5iWECT:FO NV"O <br /> N1 i ....... <br /> ....... <br /> .... .. .. ...... <br /> P"Site Constructed R'Concrete E] Masonry E] Treated Wood <br /> E] Manufactured ❑ Other(specify): <br /> P JECT AR <br /> 7. ESTIMAT :0PROJ WT.:Sul 0C x. <br /> ... <br /> :X <br /> Living area 5TI-76 Square Feet $ A�7LI52V, or <br /> I present that all the above information is correct, and understand that the issuance of this permit is for <br /> administrative purposes only. Onsite construction inspections will not and shall not be performed by the <br /> municipality which has not assumed jurisdiction per s. 101.65, Wis. Stats- I understand the Uniform Dwelling <br /> Code, Chapters ILHR 20-25,still applies to all new 1-and 2-family dwellings and must be complied with. irealize <br /> the issuance of this permit cicrh not relieve me of compliance with other applicable codes and ordinances. <br /> 00' <br /> 7:M 111�7A301(�F7 <br /> Applicant's Signature Date Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> .ISSUING JURISDICTIOW: [N] Town E] Village ❑ City E] County of: Oakland <br /> Wh Dwelling <br /> EMUNICIPALITY NUMBER: # 0 7 0 2 0 Located FEES::i1l. <br /> ated None <br /> P PEr <br /> tM1T <br /> ERMIT ISSUED BY: Burnett County Zoning Office DATE,I S Su EA,.. <br /> 5BDB 8254(R 09/94) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />